Department of Defense MANUAL

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1 Department of Defense MANUAL NUMBER , Volume 3 November 21, 2014 USD(P&R) SUBJECT: Disability Evaluation System (DES) Manual: Quality Assurance Program (QAP) References: See Enclosure 1 1. PURPOSE a. Manual. This manual is composed of several volumes, each containing its own purpose. The purpose of the overall manual, in accordance with the authority in DoD Directive (Reference (a)), is to implement policy, assign responsibilities, and provide procedures for the DES pursuant to DoD Instruction (Reference (b)). b. Volume. This volume: (1) Assigns responsibilities and procedures for the DES QAP pursuant to section 524 of Public Law (Reference (c)). (2) Incorporates and cancels the interim guidance in Assistant Secretary of Defense for Health Affairs (ASD(HA)) Memorandum (Reference (d)). 2. APPLICABILITY. This volume applies to OSD, the Military Departments, the Office of the Chairman of the Joint Chiefs of Staff and the Joint Staff, the Combatant Commands, the Office of the Inspector General of the Department of Defense, the Defense Agencies, the DoD Field Activities, and all other organizational entities within the DoD. 3. POLICY. It is DoD policy that: a. The DES will be the mechanism for determining return to duty, separation, or retirement of Service members because of disability in accordance with Reference (b). b. Each Military Department will conduct quality assurance reviews to assess the accuracy and consistency of medical evaluation board (MEB) and physical evaluation board (PEB) decisions, and to monitor and sustain the proper performance of duties of the MEBs, PEBs, and physical evaluation board liaison officers (PEBLOs).

2 4. RESPONSIBILITIES. See Enclosure PROCEDURES. See Enclosures 3 and INFORMATION COLLECTION REQUIREMENTS. The DES quarterly and annual reports, referred to in paragraphs 1b(3)(a), 1b(3)(b) and 2f of Enclosure 2 and paragraphs 2b and 4 of Enclosure 4 of this volume, have been assigned report control symbol DD-HA(A,Q)2547 as prescribed in Reference (b). 7. RELEASABILITY. Cleared for public release. This volume is available on the Internet from the DoD Issuances Website at 8. EFFECTIVE DATE. This volume is effective November 21, Enclosures 1. References 2. Responsibilities 3. QAP Review Process 4. Procedures for Data Submission and Quality Improvement Activities Glossary 2

3 TABLE OF CONTENTS ENCLOSURE 1: REFERENCES...4 ENCLOSURE 2: RESPONSIBILITIES...5 ASD(HA)...5 SECRETARIES OF THE MILITARY DEPARTMENTS...5 ENCLOSURE 3: QAP REVIEW PROCESS...7 GENERAL...7 IN-PROCESS REVIEW...7 POST-PROCESS REVIEWS...7 CONSISTENCY REVIEWS...8 ENCLOSURE 4: PROCEDURES FOR DATA SUBMISSION AND QUALITY IMPROVEMENT ACTIVITIES...10 OVERVIEW OF QAP DATA SUBMISSION...10 POST-PROCESS CASE FILE REVIEW SUBMISSION...10 POST-PROCESS CASE REVIEW ANALYSIS...10 CONSISTENCY REVIEW SUBMISSION...10 QUALITY IMPROVEMENT ACTIVITY SUBMISSION...11 DESIGNATED IDES ELECTRONIC TRACKING SYSTEM AND SURVEY DATA REPORTING...11 GLOSSARY...12 PART I. ABBREVIATIONS AND ACRONYMS...12 PART II. DEFINITIONS CONTENTS

4 ENCLOSURE 1 REFERENCES (a) DoD Directive , Assistant Secretary of Defense for Health Affairs (ASD(HA)), September 30, 2013 (b) DoD Instruction , Disability Evaluation System (DES), August 5, 2014 (c) Section 524 of Public Law , National Defense Authorization Act for Fiscal Year 2013, January 2, 2013 (d) Assistant Secretary of Defense for Health Affairs Memorandum , Post-Process Case Review Guidance: Disability Evaluation System Quality Assurance Program, July 8, 2014 (hereby cancelled) (e) Title 10, United States Code 4 ENCLOSURE 1

5 ENCLOSURE 2 RESPONSIBILITIES 1. ASD(HA). Under the authority, direction, and control of the Under Secretary of Defense for Personnel and Readiness (USD(P&R)), the ASD(HA): a. Oversees the execution of the procedures in this volume. b. Through the Deputy Assistant Secretary of Defense for Warrior Care Policy (DASD(WCP)): (1) Oversees and assesses the performance of the DES QAP in coordination with the Assistant Secretary of Defense for Reserve Affairs and the Secretaries of the Military Departments. (2) Develops QAP performance measures and goals in accordance with the USD(P&R) strategic plan. (3) Establishes reporting requirements necessary to monitor and assess the performance of the Military Departments DES QAPs and compliance with this volume. (a) No later than July 1 of each year, publishes the QAP data that the Military Departments must include as part of the DES Annual Report in accordance with the procedures in Reference (b). (b) Analyzes the QAP data individually submitted by and collectively redistributed to the Military Departments via the DES Annual Report. (c) Develops procedures and processes to conduct DES post-process case and consistency reviews and identify associated statistical sampling requirements. (d) Oversees the review, update, and publication of post-process case review checklists and other QAP requirements annually in collaboration with the Military Departments. (e) Develops constructed cases and issues these cases to the Military Departments to distribute and adjudicate. On the return of adjudicated cases from the Military Departments, evaluates the consistency of decisions. (f) In accordance with paragraph 1a of Enclosure 2 of Reference (b), the Disability Advisory Council advises and recommends improvements to the DES QAP. 2. SECRETARIES OF THE MILITARY DEPARTMENTS. The Secretaries of the Military Departments: 5 ENCLOSURE 2

6 a. Establish procedures to ensure their respective Departments comply with Reference (b), chapter 61 of Title 10, United States Code (Reference (e)), and this volume. b. Establish a QAP to: (1) Oversee policies and ensure procedures established by this volume are consistently implemented. (2) Evaluate the accuracy and consistency of MEB and PEB determinations and decisions. (3) Monitor and sustain proper performance of the duties of MEBs, PEBs, and PEBLOs. c. Develop procedures to execute the quality assurance, control, and improvement activities for the DES QAP. d. Develop procedures to perform in-process and post-process case reviews to ensure the accuracy and consistency of MEB and PEB decisions. e. Develop procedures to distribute constructed cases for adjudication and submission of the adjudicated constructed cases for evaluation by the independent review entity. f. Establish a process to compile and forward annual and quarterly DES QAP data submissions to the DASD(WCP) in accordance with the procedures in Reference (b). g. Within 120 days of the effective date of this issuance, inform the DASD(WCP) of which review entity will execute the post-process case reviews. 6 ENCLOSURE 2

7 ENCLOSURE 3 QAP REVIEW PROCESS 1. GENERAL. The DES QAP incorporates three separate reviews to ensure the accuracy and consistency of MEB and PEB decisions. These include Service-conducted in-process reviews, Service-conducted post-process reviews, and DoD-level consistency reviews. 2. IN-PROCESS REVIEWS a. The MEB convening authority reviews the recommendations of the MEB physicians to ensure the physicians have reached accurate conclusions and recommendations based on the information in the case file. b. The PEB or designated representative evaluates the accuracy and sufficiency of the case file to support adjudication. c. The PEB president or designated representative reviews the decisions made by the PEB to ensure the accuracy of the PEB decisions. Additionally, the PEB president looks at the case file to evaluate if the PEB determinations were consistent with similar cases. 3. POST-PROCESS REVIEWS a. A review entity established by the Military Department concerned will conduct independent post-process case reviews on randomly selected cases. b. The review entity will exclusively consist of personnel who have not previously previewed, reviewed, or been involved in the disability adjudication determination of such sampled cases. These personnel must: (1) Receive training and have functional knowledge with the applicable laws, regulations, and policies to execute MEB and PEB responsibilities before evaluating the accuracy of corresponding processes based on case file documentation. (2) Have functional knowledge of legal and policy requirements of the DES and respective Service medical retention standards. c. The Military Departments will provide written guidance and procedures to guide the review by the designated entity conducting post-process case reviews. The written guidance will include procedures for receiving and controlling the DES case files being reviewed. d. The Military Departments will establish processes to reconcile differences in post-process reviews versus PEB outcomes (in-process reviews) to ensure that differences are resolved before 7 ENCLOSURE 3

8 a Service member s separation from the Service and the Service member is provided an opportunity to rebut any changes as a result of post-process quality assurance review procedures. All case discrepancies must be resolved before publishing the Service member s DD Form 214, Certificate of Release or Discharge from Active Duty. e. Each QAP review process must track DES decision discrepancies and manage these decision outcomes in accordance with the Military Department regulations. f. Post-process case reviews will: (1) Occur monthly, beginning 4th quarter of fiscal year 2015, in accordance with the DASD(WCP) sampling plan published annually by the ASD(HA). (2) Be randomly selected (ensuring each case in the total population has an equal probability of selection) by the Military Department concerned from the DES inventory cases that have a final disposition date. Disability evaluation cases pending appeal decisions will not be included in the post-process case review inventory. (3) Be conducted and documented by the Military Department review entity using the standardized checklist and collection tool available to authorized Common Access Card users at the DASD(WCP) SharePoint site located at https://prext.osd.mil/ha/wcp/sitepages/default.aspx. (4) Comply with case selection criteria listed in paragraph 3f(2) of this enclosure to ensure expeditious notification to the Service member of the PEB decision. (5) Comply with the data submission requirements included in Enclosure 4 of this volume. 4. CONSISTENCY REVIEWS a. The DES QAP consistency reviews will serve as a mechanism to reduce variance in decision outcomes across the Military Departments. b. A DoD entity (external to the Military Departments) will support these reviews. The reviews will target specific issues, conditions, or high-level interest items. The DASD(WCP) will identify the specific issues, conditions, and high-level interest items. c. The external review entity develops the constructed cases from Military Department redacted cases. The DASD(WCP) will determine sampling requirements. d. Each Military Department will: (1) Receive and distribute the constructed cases in accordance with its respective consistency review planning cycle to the PEBs for adjudication. (2) Require each PEB adjudicator to participate annually in the consistency reviews. 8 ENCLOSURE 3

9 (3) Require the PEB to submit the adjudicated cases to the external review entity for evaluation and analysis. e. The DoD review entity will assess the results of the consistency reviews and submit a trend analysis to the DASD(WCP). 9 ENCLOSURE 3

10 ENCLOSURE 4 PROCEDURES FOR DATA SUBMISSION AND QUALITY IMPROVEMENT ACTIVITIES 1. OVERVIEW OF QAP DATA SUBMISSION. The DASD(WCP) and the Military Departments will use the data collected from the post-process case and consistency reviews to inform policy as to the accuracy, consistency, and proper performance of duty of the MEBs and PEBs. Customer satisfaction survey statistics and designated integrated disability evaluation system (IDES) electronic tracking system data will also be used to evaluate the proper performance of duty of MEBs, PEBs, and PEBLOs pursuant to Reference (b). Additionally, the Military Departments will submit data on quality improvement activities. 2. POST-PROCESS CASE REVIEW SUBMISSION. Each Military Department will: a. Document the results of the post-process case reviews using the protocols issued by the DASD(WCP), ensuring one checklist is completed for each case reviewed. b. Submit the results of each case reviewed to the DASD(WCP) on a quarterly basis pursuant to paragraph 2f of Enclosure 2 of this volume. The DASD(WCP) will provide a report with summary level results of the adjudications to the Military Departments. c. Track DES decision discrepancies and manage these decision outcomes in accordance with the Military Department regulations. 3. POST-PROCESS CASE REVIEW ANALYSIS. The DASD(WCP) will provide analysis and performance metrics reports to the Military Departments on post-process review accuracy, consistency, and proper performance of duty for MEBs and PEBs. 4. CONSISTENCY REVIEW SUBMISSION. An external review entity will construct, analyze, and submit the results of the adjudicated cases to the DASD(WCP) quarterly, pursuant to paragraph 2f of Enclosure 2 of this volume. The DASD(WCP) will provide a report with a summary of all Military Departments data. The data will track, at a minimum: a. Adjudication decision accuracy percentages by theme, as identified by the DASD(WCP), per Military Department. b. The degree of alignment, including significant variation, in targeted issue adjudication. c. Analysis on notable trends (e.g., longitudinal trend analysis, where applicable). d. All data annotated on the consistency review scoring tool for each case reviewed. 10 ENCLOSURE 4

11 5. QUALITY IMPROVEMENT ACTIVITY DATA SUBMISSION. The quality improvement activity data will: a. Be submitted to the DASD(WCP) on a quarterly basis pursuant to paragraph 2f of Enclosure 2 of this volume. b. Include any actions taken to address issues or trends identified in the post-process case reviews, consistency review analysis reports, designated IDES electronic tracking system quality data reports, customer satisfaction survey results, and others, as appropriate. c. Include the effectiveness of the improvement activities on the DES process or personnel executing the DES. 6. DESIGNATED IDES ELECTRONIC TRACKING SYSTEM AND SURVEY DATA REPORTING. The DASD(WCP) will provide feedback to the Military Departments on proper performance of MEBs, PEBs, and PEBLOs based on additional data sources such as, but not limited to, stakeholder and customer survey data and designated IDES electronic tracking system data. 11 ENCLOSURE 4

12 GLOSSARY PART I. ABBREVIATIONS AND ACRONYMS ASD(HA) Assistant Secretary of Defense for Health Affairs DASD(WCP) Deputy Assistant Secretary of Defense for Warrior Care Policy DES disability evaluation system IDES MEB PEB PEBLO QAP VA USD(P&R) integrated disability evaluation system medical evaluation board physical evaluation board physical evaluation board liaison officer quality assurance program U.S. Department of Veterans Affairs Under Secretary of Defense for Personnel and Readiness PART II. DEFINITIONS Unless otherwise noted, these terms and their definitions are for the purpose of this volume. consistency reviews. Targeted reviews of specific issues, conditions, or high-level interest items using constructed cases. A DoD review entity, external to the Military Departments, will construct the cases and evaluate the MEBs and PEBs performance on the targeted issues within the constructed cases. consistency review scoring tool. A scoring mechanism, such as a checklist, that uses agreed criteria and an agreed evaluation scale and process that is used as a common basis for evaluating DES cases across multiple evaluators. constructed cases. Notional DES cases based on situational facts extracted from redacted cases, with all personal identifiable information removed. Notional cases focus on targeted issues and include sufficient levels of distracting information to add realistic case evaluation conditions. DES. The DoD mechanism for determining return to duty, separation, or retirement of Service members because of disability in accordance with chapter 61 of Reference (e). Disability Advisory Council. A DoD-only group that evaluates DES functions, identifies best practices, addresses inconsistencies in policy, discusses inconsistencies in law, addresses 12 GLOSSARY

13 problems and issues in the administration of the DES, and provides a forum to develop and plan improvements. external review entity. A body composed of DoD representatives charged with developing constructed cases for standardized consistency reviews and assessing the results of consistency reviews. IDES. The joint DoD-Department of Veterans Affairs (VA) process by which DoD determines whether ill or injured Service members are fit for continued military service, and the DoD and VA determine appropriate benefits for those Service members who are separated or retired for disability. in-process reviews. Internal Military Department case file reviews at various points in the disability evaluation process intended to support the accuracy and consistency of MEB s and PEB s decisions and the reduction of the number of board decision errors. independent review entity. An independent body within the military organization concerned, separate from the DES processes. MEB. A board that is composed of two or more civilian or military physicians working for the DoD. For Service members entering the DES, the MEB conducts the medical evaluation on conditions that potentially affect the Service member s fitness for duty. The MEB documents the Service member s condition and history with a narrative summary, sometimes referred to as the MEB report. The term sometimes refers to the MEB process. MEB convening authority. A senior medical officer, appointed by the military treatment facility commander, who has detailed knowledge of standards of medical fitness and disposition of patients and disability separation processing, and who is familiar with the Veterans Affairs Schedule for Rating Disabilities. PEB. Two or more civilian or military personnel including at least one physician and one line officer which determine the fitness of Service members with medical impairments to adequately perform their military duties. PEBLO. The non-medical case manager who provides information, assistance, and case status updates to the affected Service member throughout the DES process. post process reviews. Reviews conducted by the Military Departments, using a standardized checklist to evaluate the accuracy of MEB and PEB decisions against established DoD evaluation criteria. The Military Departments will report outcomes of case file reviews in accordance with the DoD s guidance. QAP. An evaluation program designed to assess whether an organization performs work in accordance with established policy and procedures. 13 GLOSSARY

14 quality assurance. A planned and systemic pattern of all actions necessary to provide confidence that requirements are established; products and services conform to established laws, regulations, and policy; and satisfactory performance is achieved. 14 GLOSSARY

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